抑郁和焦虑障碍患者的超额死亡率：生命线队列研究。
Excess mortality in depressive and anxiety disorders: The Lifelines Cohort Study.
机构信息
Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Faculty of Medicine of Jundiaí, Internal Medicine Department, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil.
出版信息
Eur Psychiatry. 2021 Aug 31;64(1):e54. doi: 10.1192/j.eurpsy.2021.2229.
BACKGROUND
To examine the mortality risk of current and life-time depressive as well as anxiety disorders, whether this risk is moderated by sex or age, and whether this risk can be explained by lifestyle and/or somatic health status.
METHODS
A cohort study (Lifelines) including 141,377 participants (18-93 years) which were followed-up regarding mortality for 8.6 years (range 3.0-13.7). Baseline depressive and anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria were assessed with the Mini International Neuropsychiatric Interview and lifetime diagnoses by self-report. All-cause mortality was retrieved from Statistics Netherlands. Cox-regression was applied to calculate proportional hazard ratios, adjusted for lifestyle (physical activity, alcohol use, smoking, and body mass index) and somatic health status (multimorbidity and frailty) in different models.
RESULTS
The mortality rate of depressive and anxiety disorders was conditional upon age but not on sex. Only in people below 60 years, current depressive and anxiety disorders were associated with mortality. Only depressive disorder and panic disorder independently predicted mortality when all mental disorders were included simultaneously in one overall model (hazard ratio [HR] = 2.18 [95% confidence intervals (CI): 1.56-3.05], p < 0.001 and HR = 2.39 [95% CI: 1.15-4.98], p = 0.020). Life-time depressive and anxiety disorders, however, were independent of each other associated with mortality. Associations hardly changed when adjusted for lifestyle characteristics but decreased substantially when adjusted for somatic health status (in particular physical frailty).
CONCLUSIONS
In particular, depressive disorder is associated with excess mortality in people below 60 years, independent of their lifestyle. This effect seems partly explained by multimorbidity and frailty, which suggest that chronic disease management of depression-associated somatic morbidity needs to be (further) improved.
背景
本研究旨在探讨当前和终身抑郁及焦虑障碍的死亡风险，以及这种风险是否受到性别或年龄的影响，同时还探讨了这种风险是否可以通过生活方式和/或躯体健康状况来解释。
方法
本队列研究（Lifelines）共纳入 141377 名参与者（年龄 18-93 岁），随访时间为 8.6 年（范围 3.0-13.7 年），随访期间记录死亡率。根据《精神障碍诊断与统计手册》第四版标准，使用 Mini 国际神经精神访谈对基线时的抑郁和焦虑障碍进行评估，并通过自我报告评估终身诊断。所有原因的死亡率均从荷兰统计局获取。应用 Cox 回归计算比例风险比，在不同模型中，通过生活方式（体力活动、饮酒、吸烟和体重指数）和躯体健康状况（多种合并症和衰弱）进行调整。
结果
抑郁和焦虑障碍的死亡率取决于年龄，但与性别无关。仅在 60 岁以下人群中，当前的抑郁和焦虑障碍与死亡率相关。当所有精神障碍同时包含在一个整体模型中时，只有抑郁障碍和惊恐障碍独立预测死亡率（风险比[HR]分别为 2.18（95%置信区间[CI]：1.56-3.05），p<0.001 和 HR 为 2.39（95%CI：1.15-4.98），p=0.020）。然而，终身抑郁和焦虑障碍彼此独立与死亡率相关。当调整生活方式特征时，这些关联几乎没有变化，但当调整躯体健康状况（特别是身体虚弱）时，这些关联显著减弱。
结论
特别是在 60 岁以下人群中，抑郁障碍与死亡风险增加相关，独立于生活方式。这种影响部分可以通过多种合并症和衰弱来解释，这表明需要进一步改善与抑郁相关躯体疾病的慢性疾病管理。
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